Search PubMed⌕ Search

SEARCH · Search PubMed

Results for “Ventricular Function, Right”

Search indexed PubMed citations on genomics, clinical trials, systematic reviews and public health. Explore titles, authors and supplied subject terms, then open the PubMed record.

Quote a phrase for an exact phrase match. Source license links do not imply unrestricted reuse.

At least 955 records · Page 53Linked to original sources
PubMed1995

Advantages of immediate two-dimensional echocardiography in patients with acute cardiac ischemic events.

UNLABELLED: We hypothesized that the assessment of kinetic alterations on two dimensional echocardiogram (2DE) would provide greater diagnostic information than clinical symptoms and ECG changes only. The study was aimed to determine sensitivity of 2DE in patients with cardiac ischemic events and to improve the indications to thrombolysis. Three-hundred ninety-one patients (87 F; 304 M) hospitalized for suspected acute myocardial infarction (AMI), first episode, within 4 h from the onset of symptoms, suitable for thrombolysis Killip class I-II and with unstable angina (UA), were admitted in the study. Patients had to show ECG changes and alterations of segmentary motion on 2DE performed at entry, or 2DE alterations without ECG changes. The 2DE variables analyzed included right ventricular function and left ventricular systolic function. Thrombolysis was performed when 2DE and ECG changes were evidenced at the same time and when 2DE alterations without ECG changes were observed. Patients with UA treated with heparin alone were also studied. The presence of segmentary motion alterations was mandatory. RESULTS: Inferior AMIs, 87 patients (60 +/- 13 years), anterior AMI, 169 patients (61 +/- 11 years); UA group subjected to thrombolysis, 87 patients (62 +/- 12 years); UA group treated with heparin, 48 patients (62 +/- 12 years). We noted only one patient false negative, and five patients false positive. Alterations of right ventricular function were observed in 24, 14 and nine patients with inferior, anterior AMI and UA, respectively. Normal ECG at entry was observed in seven, two and seven patients with inferior, anterior AMI and UA, respectively.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1986

[Assessment of ventricular function by thermodilution in controlled ventilation with positive end expiratory pressure].

Controlled mechanical ventilation with PEEP can induce important haemodynamic modifications. The aim of this study was to focus on right ventricular function, often altered with that kind of respiratory support. Bed-side assessment of right ventricular function was made possible through thermodilution technique. Eleven patients receiving PEEP from 0 to 15 cmH2O were studied. Right ventricular end-diastolic volume (RVEDV), cardiac output (CO) and right ventricular ejection fraction (RVEF) were obtained for each patient. Increasing PEEP produced the same disturbances in nine patients, i.e. decreased RVEF. Blood volume expansion brought back to normal the haemodynamic values. Two patients had a decrease in CO and RVEF associated with an increase in RVEDV. In one of these two patients, dobutamine corrected the RV dysfunction. Using thermodilution technique, abnormalities of RV preload can be accurately assessed. From these data, the most appropriate treatment can then be chosen.

Adult↗
PubMed2005

Quantification of regional left and right ventricular longitudinal function in 75 normal fetuses using ultrasound-based strain rate and strain imaging.

Previous reports have demonstrated that myocardial velocities are not sufficiently sensitive in fetal heart studies. Strain (S) and strain rate (SR) imaging is a new noninvasive ultrasonic technique able to quantify regional myocardial deformation properties. SR imaging has a superior sensitivity than myocardial velocity for noninvasive assessment of ventricular function, but this technique has not been used in the fetal heart. Our aim was to evaluate the feasibility of S/SR imaging in the fetal heart and to study characteristics of myocardial deformation properties and their changes with the gestational age in healthy fetuses. We studied 75 normal fetuses (weeks gestation 25 +/- 4, no evidence of structural cardiovascular disease by 2-D echo and Doppler study) using S/SR imaging. Left (LV) and right ventricle (RV) peak myocardial systolic, early diastolic and SR values during atrial contraction were obtained but, for S, we measured only peak systolic values. The sample volume was placed in the mid-segment of LV septal, lateral and RV free wall. S and SR curves were obtained in all the studied population. Peak longitudinal systolic deformation was homogeneous in all the walls studied. Moreover, fetal myocardial S and SR during diastole were characterized by a higher deformation during atrial contraction than during early filling. Peak systolic and peak diastolic ratios of regional myocardial deformation properties significantly correlated with the gestational age. Inter- and intraobserver variabilities for S and SR parameters were < 15%, < 18% and < 13%, < 15%, respectively. SR imaging is feasible in selected healthy fetuses, with a limited reproducibility; we presented normal values for the fetal heart; S/SR during fetal life are homogeneous in both LV and RV; and longitudinal myocardial deformation properties increase with the gestational age.

Echocardiography, Doppler, Color↗
PubMed2005

Right ventricular myocardial performance index and exercise capacity in athletes.

Right ventricular function is important for exercise capacity in athletes. The aim of this study was to investigate the effects of habitual exercise training on right ventricular global function. Fifty-two male athletes (25 runners, 27 wrestlers) and 43 age-matched sedentary male subjects were studied. All subjects in the study underwent an echocardiography examination and cardiopulmonary exercise test. Maximal oxygen consumption, right ventricular cavity diameters, and diastolic parameters were higher in the athletes than in controls. However, the right ventricular myocardial performance index was lower in athletes compared with controls. Therefore, the right ventricular myocardial performance index showed a negative correlation with maximal oxygen consumption (r=-0.61; P<0.001). The right ventricular myocardial performance index may reflect changes in right ventricular function and exercise capacity in athletes.

Adaptation, Physiological↗
PubMed1985

Ventricular function in transposition of the great arteries: evaluation by radionuclide angiocardiography.

Right ventricular ejection fraction and tricuspid regurgitation were estimated by radionuclide angiocardiography to quantitate systemic ventricular function in "simple" transposition of the great arteries. Mean right ventricular ejection fraction was 0.52 +/- 0.07 for 18 pre Mustard operation infants, 0.54 +/- 0.07 for 23 patients operated upon less than a 1 year before, and 0.57 +/- 0.08 for 14 patients operated upon more than 3 years earlier. Eight patients were evaluated before and following the Mustard operation; ejection fraction rose in three, fell in three, and remained constant in two. Mean right ventricular ejection fraction was not different between groups nor when compared to our "normal." The left ventricle:right ventricle stroke volume ratio of the postoperative patients was compatible with tricuspid regurgitation in four patients. This radionuclide study suggests that following surgery for transposition of the great arteries: mean right ventricular systolic ejection fraction remains at levels consistent with values usually found for the "normal" right ventricle; group right ventricular function does not deteriorate in the years following surgery; and tricuspid regurgitation may be detected in the early postoperative years.

Aging↗
PubMed1979

Right and left ventricular function after the Mustard procedure in transposition of the great arteries.

Right and left ventricular function was assessed at cardiac catheterization in 33 asymptomatic patients 0.5 to 11 years (mean 4.6) after the Mustard operation for complete transposition of the great arteries. Ages at operation had ranged from 0.5 to 16 years (mean 4.2 years). Right ventricular function was assessed using videodensitometric determination of ejection fraction and ventricular volume data. Ventricular volumes were obtained by computerized video analysis utilizing Simpson's rule. The right ventricular ejection fraction was 37 +/- 11 percent (standard deviation), as assessed with videodensitometry and 42 +/- 10 percent as assessed with ventricular volume--both values less than normal (P less than 0.001). Right ventricular end-diastolic volume was significantly greater than normal (P less than 0.001) and averaged 202 +/- 70 percent, but left ventricular end-diastolic volume averaged only 125 +/- 53 percent. These observations after the Mustard operation indicate that right ventricular function is seriously decreased with relatively preserved left ventricular function. They support efforts for surgical correction utilizing the left ventricle as the systemic ventricle.

Age Factors↗
PubMedDate not supplied

Load-independent analysis of a pulsatile right ventricular assist device.

BACKGROUND: Right ventricular assist devices are becoming increasingly used as both a bridge to heart transplantation and as a means of temporary support after cardiopulmonary bypass. There has also been a resurgence of interest in pulsatile devices fueled by anecdotal, clinical reports. However, a load-independent analysis of biventricular function after right ventricular assistance comparing a pulsatile versus a continuous-flow right ventricular assist device has not been performed, and we hypothesize that a pulsatile device is less detrimental to cardiac function than a conventional, nonpulsatile pump. METHODS: Sixteen dogs (20 to 25 kg) were instrumented through a median sternotomy for placement of left ventricular and right ventricular epicardial dimension transducers in the major, minor, and septal-free wall axes. Intracavitary micromanometers were placed in both ventricles as well. Baseline pressure-dimension data were collected, and the right atrium and pulmonary artery were cannulated. Right ventricular bypass with the use of a pneumatically driven pulsatile right ventricular assist device (SV = 60 ml; n = 7) or a conventional continuous-flow centrifugal right ventricular assist device (n = 9) was instituted for a 4-hour duration. Animals were then weaned from right ventricular support and decannulated. After bypass, biventricular function data were then collected. The load-insensitive stroke work-end diastolic volume relationship known as preload recruitable stroke work was derived and expressed as a fraction of baseline function along with conventional hemodynamic indexes, cardiac output, and pulmonary vascular resistance. RESULTS: Results of this analysis show no significant benefit to either right ventricular or left ventricular function (right ventricular preload recruitable stroke work index: 0.863 +/- 0.3 [pulsatile] versus 0.849 +/- 0.2 [continuous], left ventricular preload recruitable stroke work index: 0.880 +/- 0.4 [pulsatile] versus 0.821 +/- 0.3 [continuous] after pulsatile right ventricular support. Likewise, cardiac output (1.4 +/- 0.1 [pulsatile] versus 1.5 +/- 0.2 [continuous] L/min) and pulmonary vascular resistance (4.8 +/- 1.0 [pulsatile] versus 3.2 +/- 1.1 [continuous] Wood Units) were not significantly different in either study group. CONCLUSIONS: We conclude from these data that pneumatically driven pulsatile right ventricular assist devices provide no additional benefit to myocardial performance beyond that of conventional, nonpulsatile pumps. Further studies investigating a speculative benefit from pulsatile circulatory support are necessary to further define a potential role for these novel devices.

Animals↗
PubMed1997

Right ventricular asynergy during dobutamine-atropine echocardiography.

OBJECTIVES: We sought to analyze right ventricular contractility during dobutamine infusion in patients with right coronary artery disease and to elucidate whether the development of right ventricular asynergy aids in characterizing a right coronary artery stenosis. BACKGROUND: Clinical investigations are emphasizing the importance of right ventricular function in patients with coronary artery disease. Thus, prognosis of patients with inferior myocardial infarction is influenced by right ventricular function. This study describes the echocardiographic and electrocardiographic findings during dobutamine-atropine echocardiography in patients with right coronary artery disease. METHODS: We studied 31 patients with isolated right coronary artery disease and no previous myocardial infarction. Six patients with poor acoustic window were excluded (feasibility 80%). The remaining 25 patients underwent dobutamine-atropine echocardiography. A right coronary artery stenosis located before the origin of the right ventricular branches was considered proximal; otherwise, it was considered distal. RESULTS: Right ventricular asynergy during dobutamine-atropine testing developed in 17 patients (sensitivity 68%); 14 had proximal and 3 had distal right coronary artery disease. The following segments were involved: inferior (n = 17), lateral (n = 5) and outflow tract (n = 1). No patient showed anterior asynergy. All 17 patients had left ventricular asynergy as well. Ischemia-free time was 10.7 +/- 6.2 (mean +/- SD) min for the right ventricle and 8.9 +/- 5.2 min for the left ventricle (p < 0.05). Ischemic ST changes were recorded in 15 patients (in standard leads in 14 and in right precordial leads in 8). All patients with right precordial changes showed ST elevation and had right ventricular asynergy (sensitivity and specificity for right ventricular asynergy 47% and 100%, respectively). A control group of 25 patients with no right coronary artery disease (5 with no disease, 15 with left anterior descending and 5 with left circumflex coronary artery disease) underwent dobutamine echocardiography. Right ventricular asynergy developed in two patients with left anterior descending artery stenosis (specificity 92%); in both, the anterior wall was affected. CONCLUSIONS: Echocardiography during dobutamine infusion is a reliable technique for assessing right ventricular dysfunction in patients with right coronary artery disease. Right ventricular contractility can be assessed during dobutamine echocardiography in selected patients.

Aged↗
PubMed1997

Tricuspid valve repair in children with hypoplastic left heart syndrome during staged surgical reconstruction.

BACKGROUND: The purpose of this study was to determine the incidence of moderate to severe tricuspid valve regurgitation in children with hypoplastic left heart syndrome (HLHS) undergoing staged surgical reconstruction, to assess the mechanisms responsible, and to evaluate the efficacy of surgical repair. METHODS AND RESULTS: We retrospectively reviewed clinical and echocardiographic data of 59 consecutive patients with HLHS operated on at our institution. Patients with a moderate or severe degree of tricuspid regurgitation (> or =2+) demonstrated by color flow Doppler echocardiography before the hemi-Fontan or Fontan operation who underwent tricuspid valve repair were included. Patients with HLHS and coexisting atrioventricular septal defect were excluded from the study. Severity of insufficiency was graded on a scale from 1 to 4+ by Doppler color flow mapping. Tricuspid valve morphology, degree of tricuspid valve regurgitation, and right ventricular function were assessed before and after tricuspid valvuloplasty. Eight patients (8/59; 14%) were found to have a minimum of 2+ tricuspid valve regurgitation before hemi-Fontan or Fontan operations. In five of eight patients (62%; Group A), the valve was found to be myxomatous, thickened, and redundant. There were multiple regurgitant jets in three of five (60%) patients in this group. In three of eight patients (37%; Group B), the valve had a normal echocardiographic appearance and regurgitation was the result of a lack of complete leaflet coaptation. All eight patients underwent tricuspid valvuloplasty, and all experienced a decrease in regurgitation. In five of eight (62%) patients, there was a reduction in insufficiency of two grades of severity and in three of eight (37%) patients, there was a one-grade improvement. Tricuspid valve stenosis was not documented in any of the patients after tricuspid valvuloplasty. In seven of eight (87%) patients, right ventricular function was assessed as fair before tricuspid valvuloplasty repair and improved to good in five of seven (71%) patients after the procedure. The remaining patient had good function both at baseline and after tricuspid valvuloplasty. CONCLUSIONS: Moderate to severe tricuspid valve regurgitation is a common finding in patients with HLHS undergoing staged surgical reconstruction and can result from either abnormal valve morphology or incomplete leaflet coaptation. Tricuspid valvuloplasty during either the hemi-Fontan or Fontan stages of reconstruction carries a high success rate and is associated with improved right ventricular function.

Child↗
PubMed1983

Myocardial contusion in chest trauma.

Because myocardial dysfunction may result from severe trauma, the author assessed, prospectively, left and right ventricular function in 25 patients who had sustained severe trauma, including blunt chest injury, by electrocardiographically gated blood pool radionuclide angiography. Focal abnormalities of ventricular wall motion were defined in 17 patients: right ventricular in 12, left ventricular in 2 and biventricular in 3. Traumatic tricuspid insufficiency demonstrated in two patients was subsequently verified by contrast angiography. Other means of detecting myocardial contusion (enzymatic, electrocardiographic and scintigraphic) proved to be insensitive when compared with radionuclide angiography. Two of the five deaths were attributed to refractory arrhythmias. Surgical or autopsy evidence of traumatic myocardial injury was obtained in five instances when radionuclide angiography indicated contusion. Of the 13 patients available for follow-up, 11 showed complete or partial resolution of the ventricular wall abnormality and in 2 there was no change. Comprehensive cardiopulmonary monitoring revealed an inverse relation between the right ventricular ejection fraction and pulmonary vascular resistance as well as between the pulmonary vascular resistance and left ventricular ejection fraction and left ventricular end-diastolic volume. Further, as the right ventricular end-diastolic volume was increased in trauma, left ventricular function and compliance were reduced. In blunt chest trauma, right ventricular contusion occurs more frequently than has been recognized previously and positive radionuclide angiography constitutes prima facie evidence of direct myocardial injury. Moreover, left ventricular function remains preload-dependent, but may be depressed by elevated pulmonary vascular resistance, impeding the blood flow from the right to left ventricle, and decreased left ventricular compliance, or both.

Accidents, Traffic↗
PubMed2004

[The right ventricle: role of Doppler echocardiography in clinical practice].

To date, right ventricular function can be clinically assessed by Doppler echocardiography. Monodimensional and two-dimensional echocardiography provide information about right ventricular dimensions, wall thickness and tricuspid annular plane systolic excursion, which is an accurate estimate of longitudinal systolic function. Additional insights into right ventricular systolic function are given by Doppler interrogation of right ventricular outflow, measuring the duration of systolic time intervals. The Doppler recordings of the tricuspid inflow and hepatic venous flow allow the assessment of right ventricular diastolic properties. Also the new ultrasound technologies are clinically useful. The myocardial velocities and time intervals, detectable by pulsed tissue Doppler at the level of the tricuspid annulus, are markers of systolic and diastolic longitudinal motion of the right ventricle. The off-line strain rate imaging permits quantification of right ventricular myocardial contractility and may be particularly useful for the assessment of congenital cardiomyopathies. The right ventricular filling pressure and pulmonary arterial pressure may be derived by the combined analysis of the grade of tricuspid regurgitation and the respiratory reactivity of the inferior vena cava. The systolic time intervals, measured at the level of the right ventricular outflow, represent estimates of changes in pulmonary vascular resistance. The prognostic value of Doppler echocardiographic measurements of right ventricular function is demonstrated in various pathologies. This evaluation also provides additional value for the risk stratification of patients with chronic heart failure.

Diastole↗
PubMed1983

[Diastolic filling of the right ventricle in hypertrophic cardiomyopathy studied with 2-dimensional Doppler echocardiography].

Inflow pattern at the tricuspid orifice was examined using two-dimensional Doppler echocardiography. The cases examined consisted of 24 cases of hypertrophic cardiomyopathy (HCM), 10 cases of left ventricular hypertrophy (LVH) due to hypertension or aortic valvular stenosis and 23 healthy subjects. The right ventricular inflow pattern in HCM was characterized by a slow deceleration of a rapid filling wave, an increase in the duration of an inflow due to atrial contraction and an increased ratio of the peak velocity in atrial contraction phase to that in rapid filling phase (A/R). No definite difference was noted in the right ventricular inflow pattern between HCM with and without left ventricular obstruction. The abnormalities in the right ventricular inflow pattern in LVH were similar to those in HCM. The abnormal inflow patterns in HCM and LVH suggested a reduced distensibility of the right ventricle in early diastole and the compensatory augmentation of right atrial contraction. The changes in the deceleration of the rapid filling wave and A/R ratio were significantly correlated with interventricular septal thickness (base and papillary muscle levels) in cases with LVH. This result seemed to indicate that the changes in the right ventricular inflow are mainly resulted from the influence of hypertrophy of the interventricular septum on right ventricular function. There was hypertrophy of the interventricular septum in all cases of HCM and, in addition, that of the right ventricular anterior wall in some of them. The changes in the inflow pattern in HCM are also considered to be resulted from hypertrophy of the right ventricular anterior wall and the influence of hypertrophy of the interventricular septum on right ventricular function. However, in the cases of HCM, the extent of the changes showed no significant correlation with right ventricular anterior wall thickness and interventricular septal thickness. In HCM, hypertrophy of the interventricular septum and right ventricular free wall may coexist, and ventricular hypertrophy is often nonuniform and may exhibit disarrangement in myocardial architecture. Therefore, influential factors on the right ventricular inflow are considered to be more complicated in HCM than in LVH, resulting in the absence of significant correlation to the abnormal inflow mentioned above.

Adolescent↗
PubMed2004

Associations of right ventricular myocardial function with skin and pulmonary involvement in asymptomatic patients with systemic sclerosis.

BACKGROUND: Systemic sclerosis (SSc) is a multisystem disorder characterized by widespread vascular lesions and fibrosis of the skin and specific internal organs. Cardiac involvement is a common finding in SSc, but often clinically occult. The aim of the present study was to analyze both left and right ventricular (RV) myocardial function in patients with SSc, and their relation to other instrumental features of the disease. METHODS: Twenty-five healthy subjects and 23 age- and sex-comparable asymptomatic patients classified as having either diffuse (11 patients) or limited cutaneous (12 patients) SSc underwent clinical examination, serological analysis, high-resolution chest computed tomography, standard Doppler echocardiography and pulsed Doppler myocardial imaging (DMI) of both the mitral and tricuspid annuli. SSc was classified using the modified Rodnan skin score (mRSS) into high mRSS (score > or = 10) and low mRSS (score < 10). RESULTS: Serological antibody analysis revealed the presence of antinuclear antibody in all patients, an anticentromere pattern in 8 patients, and anti-Scl-70 antibodies in 15 patients. Eleven patients were diagnosed with interstitial pulmonary fibrosis at chest computed tomography. Standard Doppler echocardiography revealed that the left ventricular mass index and ejection fraction were comparable between the two groups, while the RV end-diastolic diameter was increased in SSc (p < 0.01). The tricuspid inflow peak E and E/A ratio were slightly decreased in SSc (p < 0.01), while the systolic pulmonary pressure was increased (p < 0.0001). DMI analysis revealed, in SSc, an impaired RV myocardial early-diastolic (Em) peak velocity (p < 0.001) as well as a prolonged myocardial relaxation time (RTm) (p < 0.001) only at the tricuspid annulus level, even after correction for age, sex, heart rate and left ventricular mass index. Independent inverse associations of the RV Em peak velocity with both the Rodnan skin score (beta coefficient = -0.62, p < 0.0005) and the pulmonary systolic pressure (beta coefficient = 0.71, p < 0.0001), as well as the independent inverse correlation of the same RV Em peak velocity with interstitial pulmonary fibrosis (odds ratio 0.68, 95% confidence interval 0.45-0.83, p < 0.0005) in SSc patients were assessed at multivariate analysis. In addition, the RV Em velocity was an independent predictor of the anti-Scl-70 antibody pattern (odds ratio 0.68, 95% confidence interval 0.45-0.83, p < 0.01). Of note, a RV Em peak velocity < 0.11 m/s well selected SSc patients with pulmonary artery pressure > 35 mmHg, pulmonary fibrosis, a high mRSS, and an anti-Scl-70 antibody pattern. CONCLUSIONS: The relationships of RV myocardial diastolic dysfunction with both skin and pulmonary involvement as well as with the serological antibody pattern emphasizes the ability of DMI to identify patients with a more diffuse and severe form of SSc. This issue may be critical for the early identification of those SSc patients who are at higher risk of cardiac impairment, ideally when they are still asymptomatic before developing severe vasculopathy.

Case-Control Studies↗
PubMed1989

Cardiac function during long-term hypoxemia in fetal sheep.

To examine right ventricular function during long-term hypoxemia, we instrumented 12 fetal sheep with intravascular catheters and an electromagnetic flow probe on the pulmonary artery. In six cases, hypoxemia was induced by infusing N2 gas into the maternal trachea for 2 wk. Maternal arterial PO2 was less than 60 Torr, and fetal arterial PO2 was reduced from approximately 26 to approximately 19 Torr. Six cases served as nonhypoxic controls. We studied fetal cardiac function by increasing either preload with a volume infusion of 5% (wt/vol) dextrose or afterload by administering methoxamine (alpha-adrenergic agonist). In hypoxic animals, right ventricular output (QRV) and stroke volume (SV) were not affected on the first 2 days but fell 30% on day 3. Fetal arterial pressure (Pfa) increased 20%, hemoglobin concentration increased approximately 30%, and fetal heart rate (FHR) showed minimal changes. Within 2 wk, QRV recovered to normal values, whereas ventricular sensitivity to arterial pressure was reduced. We observed no change in plasma concentration of "cardiac enzymes" or differences in fetal growth between groups. In conclusion, during prolonged hypoxemia, right ventricular function showed a triphasic response (primary maintenance, secondary depression, and subsequent recovery), achieving a new steady state 2 wk after the start of hypoxia, characterized by decreased sensitivity to afterload, associated with polycythemia and hypertension.

Animals↗
PubMed2005

Disturbed right ventricular diastolic function in patients with systemic sclerosis: a Doppler tissue imaging study.

BACKGROUND: Cardiopulmonary involvement in patients with systemic sclerosis (SSc) carries a poor prognosis, mainly due to pulmonary hypertension and right-heart failure. To date, right ventricular (RV) involvement has not been studied in detail. We therefore assessed RV function in patients with SSc and related the findings to the clinical features of the disease. METHOD: Twenty-six consecutive patients (21 women) with SSc (mean age, 56 +/- 15 years [+/- SD]) and 25 healthy, age-matched control subjects (21 women) were studied. Doppler echocardiography including Doppler tissue imaging was used to evaluate cardiac function. Pulmonary function was also studied. RESULTS: Compared with control subjects, RV free wall thickness (5.8 +/- 1.7 mm vs 3.7 +/- 1.1 mm, p < 0.001) and right atrial (RA) systolic area (15.9 +/- 3.7 cm2 vs 13.0 +/- 2.3 cm2, p < 0.01) were increased in patients with SSc, while the global early diastolic/atrial component velocity ratio was reduced (1.2 +/- 0.4 vs 1.7 +/- 0.6, p < 0.01). The global isovolumic relaxation time (IVRT) [64 +/- 23 ms vs 39 +/- 13 ms, p < 0.001] and regional IVRT (83 +/- 40 ms vs 46 +/- 24 ms, p < 0.001) were prolonged in patients vs control subjects, whereas the RV global filling time was reduced (454 +/- 122 ms vs 548 +/- 104 ms, p < 0.01). RV systolic function and pulmonary pressures at rest were similar in the two groups, but the pulmonary artery acceleration time was reduced (119 +/- 34 ms vs 141 +/- 29 ms, p < 0.05) in patients compared to control subjects. Left ventricular function did not differ between the two groups. CONCLUSION: Patients with SSc exhibit altered RV diastolic function together with an increase in RV wall thickness and RA area. These findings appear to be early markers of RV disturbance, probably in response to intermittent pulmonary arterial hypertension.

Adult↗
PubMed1991

Transesophageal echocardiographic evaluation in mechanically assisted circulation.

Transesophageal echocardiography (TEE) has assumed an increasing importance in cardiothoracic surgery, but its use in patients with mechanically assisted circulation is unclear. We performed TEE in 11 patients: total artificial heart (TAH) 2, right ventricular assist device (RVAD) 2, left ventricular assist device (LVAD) 6, biventricular assist device (BVAD) 1. TEE was helpful in three areas. (1) selection of the assist device (AD): evaluation of left and right ventricular function allows differentiation of left, right or biventricular failure. (2) management of patient and optimization of pump performance: in all patients, correct cannula position and pump flow could be identified. Right ventricular failure in the presence of LVAD was found to cause hemodynamic instability in 4 patients. In 1 patient with repeated RV dilation and hypotension despite RVAD, TEE allowed optimal pump settings to be determined. (3) weaning from AD: Recovery of ventricular function can be assessed prior to weaning and repeatedly monitored during weaning. TEE in TAH is limited to problems such as identification of atrial thrombus or inflow valve dysfunction. We conclude that TEE is useful in the setting of mechanically assisted circulation for AD selection, improvement of patient management, optimization of pump performance and during weaning from AD.

Assisted Circulation↗
PubMed1996

Nitric oxide improves transpulmonary vascular mechanics but does not change intrinsic right ventricular contractility in an acute respiratory distress syndrome model with permissive hypercapnia.

OBJECTIVE: To test the hypothesis that in a swine model of acute respiratory distress syndrome (ARDS) with permissive hypercapnia, inhaled nitric oxide would improve transpulmonary vascular mechanics and right ventricular workload while not changing intrinsic right ventricular contractility. DESIGN: Prospective, randomized, controlled laboratory trial. SETTING: University research laboratory. SUBJECTS: Eleven swine (30 to 46 kg). INTERVENTIONS: The swine were anesthetized, intubated, and paralyzed. After median sternotomy, pressure transducers were placed in the right ventricle, pulmonary artery, and left atrium. An ultrasonic flow probe was placed around the pulmonary artery. Ultrasonic dimension transducers were sutured onto the heart at the base, apex, left ventricle (anterior, posterior, free wall), and right ventricle (free wall). An additional transducer was placed in the interventricular septum. A surfactant depletion model of ARDS was created by saline lung lavage. Nitric oxide was administered at 2, 4, and 6 parts per million (ppm), in a random order, under the condition of permissive hypercapnia (Paco2 55 to 75 torr [7.3 to 10.0 kPa]). MEASUREMENTS AND MAIN RESULTS: We evaluated the pulmonary vascular and right ventricular effects of permissive hypercapnia, with and without inhaled nitric oxide, by measuring variables of transpulmonary vascular mechanics and right ventricular function. These variables included mean pulmonary arterial pressure, right ventricular total power, right ventricular stroke work, transpulmonary vascular efficiency, and right ventricular intrinsic contractility. Data were obtained after lung injury under the following conditions: a) normocapnia (Paco2 35 to 45 torr [4.7 to 6.0 kPa]) and nitric oxide at 0 ppm; b) hypercapnia and nitric oxide at 0 ppm; c) hypercapnia and nitric oxide at 2, 4, and 6 ppm; and d) repeat measurements with hypercapnia and nitric oxide at 0 ppm. In ARDS with permissive hypercapnia, inhaled nitric oxide therapy (2 to 6 ppm) improved transpulmonary vascular mechanics and right ventricular workload by lowering pulmonary arterial pressure (29.6 +/- 1.3 vs. 24.6 +/- 1.0 mm Hg, p = .0001), increasing transpulmonary vascular efficiency (13.9 +/- 0.5 vs. 16.1 +/- 0.7 L/W-min, p = .0001), decreasing right ventricular total power (142 +/- 9 vs. 115 +/- 9 mW, p = .001), and decreasing right ventricular stroke work (653 +/- 37 vs. 525 +/- 32 ergs x 10(3), p = .001). Inhaled nitric oxide did not change right ventricular contractility, as measured by preload-recruitable stroke work. CONCLUSIONS: Inhaled nitric oxide ameliorated any negative effects of hypoxic and hypercapnic pulmonary vasoconstriction. The beneficial effects of inhaled nitric oxide are related to alterations in right ventricular afterload and not intrinsic right ventricular contractility. The improved cardiopulmonary effects of inhaled nitric oxide with permissive hypercapnia potentially expand the use of nitric oxide in ARDS and other conditions in which this strategy is employed.

Animals↗
PubMed1999

Portopulmonary hypertension and the liver transplant candidate.

The management of the liver transplant (OLT) candidate with portopulmonary hypertension (PPHTN) has dramatically changed in the past 3 years. Careful preoperative evaluation with functional characterization of right ventricular function plays a critical role. The pulmonary vascular response to epoprostenol infusion serves as a deciding factor for OLT candidacy. Careful perioperative attention to avoid right ventricular failure from acutely elevated pulmonary artery pressures or sudden increases in right ventricular preload is a key physiologic tenet of management. With increased surgical expertise, anesthetic sophistication, and availability of epoprostenol, PPHTN is no longer considered an absolute contraindication for OLT.

Humans↗